Three Plead Guilty In S. FL Medicare Scheme

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(TM and © Copyright 2013 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2013 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)
Source: cbslocal.com

Video: Florida Medicare Supplements

Florida Medicare Advantage Plans from Freedom Health

Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid.
Source: qooqe.com

AARP Florida Statement and Video on Medicare’s 48th Anniversary

“As Medicare continues to provide access to health care for millions of seniors and those with disabilities, AARP is celebrating its 48 successful years and advocating for responsible, commonsense solutions that will strengthen the program by lowering drug costs, improving care coordination and cracking down on over-testing, waste and fraud. Nearly 50 million Americans—15 percent of the nation’s population, and growing—depend on Medicare for health security which is why AARP will continue our work to ensure that it is there for current and future generations.
Source: aarp.org

Issue Age, Community Rated, & Attained Age Medigap Pricing Explained

3.  Attained-Age:  Medicare Supplement (Medigap) premiums are based on your current age and are scheduled to go up each year with your age (Happy Birthday!).  Attained-Age plans may start out as the lowest cost when comparing but could end up the highest monthly cost as you get older.  For example, Mrs. Williams buys a Florida Medigap plan N at age 66 for $145/month.  At age 67 the plan is scheduled to rise to $149/month and at age 68 to $156.  Prices are going up each year you have the policy as scheduled.
Source: floridamedicareplans.com

FBI — Former Office Manager for Health Care Solutions Network Sentenced in $63 Million Medicare Fraud

Court documents reveal that Palmero was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the fabrication of medical records by preparing, and causing others to prepare, documentation that was later utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.
Source: fbi.gov

Florida Blue Medicare Plans

These days, everyone is looking for a few ways to save money. With Florida Blue Medicare plans, securing a low rate is easy because they can offer discounts and reduced rates that many newer companies cannot. The reason is simple. Florida Blue has been serving the residents of Florida for generations and they’ve built a solid customer base of happy satisfied clients. As a consequence, they’re not driven by profit margins, and don’t need to be concerned with building a loyal following. Instead, they can offer deep discounts and low rates creating the most affordable Medicare plans to keep you happy.
Source: frederiksted.org

Florida Elder Law and Estate Planning: Alert to Medicare beneficiaries: Ignore scammers pitching marketplace plans!

If you are 65 and older and receiving Medicare benefits, forget about the Affordable Care Act and the new marketplace insurance exchanges. You do NOT need to purchase new coverage through your state’s insurance marketplace. Says Richard Olague, spokesman for the Centers for Medicare and Medicaid Services: “We want to reassure Medicare beneficiaries that they are already covered, that their benefits aren’t changing and that the marketplace doesn’t require them to do anything different. Specifically, they do not have to change their Medicare coverage or enroll in any marketplace plan.”
Source: blogspot.com

Stories from the Field: Medicare Fraud in South Florida

The agency’s purpose is to enroll Medicare beneficiaries in their fraudulent health care program, cancelling their current Medicare plans and leaving them without the ability to receive crucial benefits. In order to carry out this scam, the agency takes advantage of the economic insecurity that many Hispanic older adults face. A recent report showed that 70.1% of Hispanic older adults live of the verge of poverty – the highest of any racial/ethnic group in the U.S. Aware of this fact, the scammers offer the beneficiaries much needed money to enroll in fraudulent health care plans. Since many live in poverty and are forced to choose between food, medication or housing, this extra money can be the difference between going to bed hungry and eating a filling dinner. In addition to this “signing bonus,” the agency attracts new clients by offering access to its beauty salon and gym.
Source: nhcoa.org

Let’s go to sunny Florida for the 9th Annual Medicare Congress

This is the largest and most sought after conference focused solely on Medicare Advantage. Health plans need the crucial information provided at this conference to stay competitive with ACOs, optimize their Star Ratings, withstand potential audits and sanctions, and shape their business plans in light of the uncertain outcome of the 2012 elections.
Source: themtmist.com

Feds approve Medicaid waiver for “private option”

Posted by:  :  Category: Medicare

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The feds today approved a waiver of federal Medicaid rules to allow Arkansas to pursue the so-called “private option” plan for Medicaid expansion. The waiver covers three years, after which the program will be evaluated, with the potential for renewal. Here is the letter from the Center for Medicare and Medicaid Services (CMS)sent to the Arkansas Department of Human Services this morning. Secretary Kathleen Sebelius of the federal Health and Human Services also called Gov. Mike Beebe this morning to tell him the news.  The “private option” expands health coverage to more than 200,000 people below 139 percent of the federal poverty level (around $16,000 for an individual or $32,700 for a family of four). Rather than covering these low-income Arkansans via the traditional Medicaid program, the state will use Medicaid funds to pay for the full premiums of private health insurance plans that beneficiaries select on the Health Insurance Marketplace.  The federal government will pay for 100 percent of the program during the three years of the waiver demonstration period. If it continued beyond three years, the state would start chipping in, eventually up to 10 percent in 2020 and beyond.  I was in Conway filming “Arkansas Week” when the news broke, so I’m playing catch-up. Updates to come. Here is a statement from Emma Sandoe, spokeswoman at the CMS:  CMS is pleased to approve Arkansas’s Medicaid 1115 Waiver application. Arkansas and CMS worked together to find flexibilities that gave the state the tools to build a program that worked for them and their residents. We appreciate the collaboration with Arkansas throughout the process and applaud their commitment to providing Arkansans with access to high, quality health coverage. Beebe’s statement:  Arkansas came up with its own plan to expand Medicaid using the private-insurance market, and Secretary Sebelius and her team worked to ensure that we had the flexibility to make that plan a reality,” Governor Beebe said. “Our actions have drawn positive attention from across the country, and now we will focus on getting this insurance to the Arkansans who need it to lead healthier, more productive lives. Hopefully, this bipartisan, intergovernmental achievement can be an example for Congress as the government shutdown looms. Statement from DHS:  It’s a big day for Arkansas. It marks the end of a very long and intense process following Governor Beebe’s signing of the Health Care Independence Act in April. There is, of course, much more work to do as we move into implementation and the next phases of the program. But today we’re taking the time to celebrate the approval of this unique and innovative program that will provide much-needed health care for hundreds of thousands of Arkansans. We would not be where we are today without the extraordinary efforts of our staff and the team in Washington who helped us through this process. They did a tremendous amount of work in a very short time to make this happen.  Thespecial terms and conditions explain the nuts and bolts of what CMS expects from the state. For a closer look at the budget neutrality requirements the feds imposed on the state — which set limits on spending, with the state on the hook if costs run above the targets, see this post. Joan Alker of the Georgetown University Health Policy Institute, offers some preliminary thoughts here. 
Source: arktimes.com

Video: Arkansas Medicare Advantage Plans and Supplement Insurance

Funding Details: Arkansas Medicare Rural Hospital Flexibility Grant Program (CAH/FLEX)

Participating Critical Access Hospitals will receive a comprehensive audit of cost, revenue and departmental productivity performance, including an analysis of top recommendations that will result in greater financial and operational improvement based on internal and external benchmarks. Hospitals will analyze the information provided and select one or more improvement interventions.
Source: raconline.org

Will Tennessee (Or Florida) Now Follow The “Lead” Of Arkansas — Allow Medicaid Money To “Buy” Private Insurance?

. . . .The Centers for Medicare and Medicaid Services announced the compromise in an e-mail four days before the debut of state insurance exchanges created under the Affordable Care Act. The plan may cost the federal government as much as $1.1 billion in its first year. The health law sought to have states expand existing government-managed Medicaid programs for the poor next year to cover everyone earning about one-third more than the U.S. poverty level.
Source: wordpress.com

This Hour: Latest Arkansas news, sports, business and entertainment

The contract called for spending federal money on television, radio and newspaper advertising as well as direct mail and billboards to promote the exchange. About 500,000 Arkansans are expected to participate in the health insurance exchange, with open enrollment set to begin Tuesday.
Source: wmctv.com

Brad DeLong : Ann Marie Marciarille: The Private Option for Medicaid Expansion: Noted

I appreciate that the Missouri version of Arkansas-style Medicaid Expansion is being circulated without name as “Rough Draft No. One.” The shoe fits. As far as I can tell, the proposal mimics in essentials Arakansas’ 1115 waiver application… http://humanservices.arkansas.gov/dms/Documents/Final%201115%20Waiver%20Materials%20for%20Submission.pdf…. The “rationale” section of the Arkansas 1115 waiver application is the most interesting:
Source: typepad.com

The Arkansas Medicaid Model: What You Need To Know About The ‘Private Option’

A: No. The Department of Health and Human Services has said it will consider “a limited number” of Arkansas-style plans in which Medicaid beneficiaries would use federal dollars to buy private policies.  Arkansas must give HHS a detailed proposal.  A federal green light is no sure thing, given the plan’s departure from traditional practice and a requirement that it be cost effective. “We haven’t approved anything,” Marilyn Tavenner, acting administrator of HHS’s Centers for Medicare and Medicaid Services, said at a confirmation hearing in April.
Source: kaiserhealthnews.org

New Arkansas Law Calls for ASC Medicaid Reimbursements at 80% of Medicare Hospital Rate

A recently-enacted Arkansas law calls for certain Medicaid procedures performed in ambulatory surgery centers to be reimbursed at 80 percent of the Medicare rate paid for the same procedure at a hospital outpatient department. The goal of House Bill 1968, according to its official language, is to decrease Medicaid costs while increasing access to care for that state’s Medicaid population.
Source: beckersasc.com

U.S. clears Arkansas Medicaid expansion proposal

About 8.7 million new beneficiaries are expected to enroll in Medicaid in 2014 alone, while another 7 million are expected to buy insurance through the state exchanges. CMS said the Arkansas decision meant that most of the newly eligible Medicaid beneficiaries will buy their insurance on the state exchange.
Source: typepad.com

Texas Home Health Companies Sue Government Over Medicare Privileges

Posted by:  :  Category: Medicare

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AAHomecare AARP Almost Family Almost Family Inc. Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Avalere Health Brookdale Senior Living Care.com CellTrak Technologies Inc. Center for Medicare & Medicaid Services Centers for Medicare & Medicaid Services CliftonLarsonAllen CMS Department of Health and Human Services Department of Justice Emeritus Senior Living featured Federal Bureau of Investigation Gentiva Health Services Inc. HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare Kindred Healthcare Inc. LHC Group NAHC National Association for Home Care & Hospice New England Home Healthcare Consortium New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Health Care Partnership for Quality Home Healthcare PHI Scripps Health The Partnership for Quality Home Healthcare VA Visiting Nurses Association Wall Street Journal
Source: homehealthcarenews.com

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

MedicareBob’s Blog: Anderson County Texas Medicare Supplement Quotes

The three most comprehensive Medicare Supplement Plans are: Medicare Supplement Plan F: Full Coverage Medicare Supplement Plan G: Small Deductible ($147.00) Medicare Supplement N: Small Deductible & Copays (Part B Excess
Source: blogspot.com

Medicaid Waiver Fosters Collaboration, North Texas Hospital CEOs Say

The Texas Medicaid Waiver 1115 is formally known as the Texas Health Care Transformation and Quality Improvement Program. The waiver was a response to the expansion of Medicaid managed care during the 2011 legislative session. The federal government reduces upper payment limit funding under HMOs, and UPL payments were designed to help compensate for the fact that Medicaid only pays hospitals about half of the cost of care. The program pays Texas hospitals about $3 billion annually.
Source: dmagazine.com

Atascosa County Texas Medicare Supplement Quotes

Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Atascosa County Texas, Atascosa County Texas Cheapest Medicare supplement rates, Atascosa County Texas cost effective Medicare supplement rates, Atascosa County Texas Medicare, Atascosa County Texas Medicare Supplement Quotes, Atascosa County Texas Medicare Supplements, Atascosa Texas supplement quotes, Best Supplement, Cheapest Premium, Cigna Supplement, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, Texas Medicare, Texas Medicare Agent, Texas Medicare Supplement Quotes, United Healthcare Supplement, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Medicare gives Texas hospital 90 days to shape up

The agency gave the hospital until Oct. 6 to fix the problems or lose funding. “We’ve still got work to do, and that’s our focus,” said Carrie Williams, spokeswoman for the Texas Department of State Health Services, which operates state hospitals. “The extra time will let us continue to work on the hospital, make improvements and meet the standards we expect from our state hospitals.” The Medicare agency was expected to reveal its detailed findings at the end of the month after the state has a Medicare-approved plan to remedy the hospital’s shortcomings, the American-Statesman reported. The investigation began in April after the American-Statesman made the agency aware of the 2012 death of Terrell State Hospital patient Ann Simmons. The 62-year-old woman died at the hospital 30 miles east of Dallas after being left in restraints for 55 hours. Medicare investigators concluded that improper care was responsible for her death and a continued threat to the lives of other patients. After warning the state of urgent deficiencies, which the state has remedied, the Medicare agency began a comprehensive investigation of the hospital. The agency’s letter stemmed from that investigation, the American-Statesman reported. Since April, state officials have forced the hospital’s superintendent to resign and closed its 20-bed medical unit.
Source: modernhealthcare.com

Southeast Texas Seniors Guide to Medicare Advantage Plans Courtesy of the EPO Physician Network : SETX Seniors

Cost if you rarely visit doctors. If you rarely have to go to a doctor, your out-of-pocket costs will generally be lower with a Medicare Advantage Plan than if you enroll in original Medicare and buy a Medicare supplement policy. Some Medicare Advantage plans don’t charge a premium in addition to the Medicare Part B premium but will have deductibles, coinsurance, and copayments that you’ll have to pay. If you see doctors frequently, the plan may cost more even if you don’t pay a premium to the plan.
Source: setxseniors.com

Texas Children’s Hospital Goes To Court Over Medicaid Cutback

“We’re trying to balance being available for all our kids, we don’t differentiate by who can pay. So when 55% of our kids are Medicaid, you know, we want to balance that equation to figure out a way to sustain ourselves on that.”
Source: kuhf.org

Who Pays For Hospice Care In Texas?

Medicare—If a person is terminally ill and is a Medicare beneficiary using a Medicare-certified hospice provider, 100 percent of hospice services are covered. In 2011, 84.1 percent of hospice patients were covered by the Medicare hospice benefit.  Hospice payments are separate from Medicare payments for other illnesses, diseases or care the patient may be receiving. 
Source: cbslocal.com

AFP to TX Delegation: Oppose Medicare Part D Rebate Proposals : The Katy News

Created in 2006, Medicare Part D provides prescription drug coverage for Medicare beneficiaries. The program has successfully used market mechanisms, such as competition and choice, to improve access and control costs, making it an anomaly among government programs. Beginning with his State of the Union in January, President Obama is promoting a proposal that taxes the Medicare Part D programs in order to pay for higher levels of spending in other areas of government.
Source: thekatynews.com

Ways to prevent Medicare fraud in Texas before it occurs

Strong evidence indicates that isolated pockets of home health providers are abusing the Medicare program. Analyses show, as detailed in your article, Texas is home to high levels of aberrant behaviors. In fact, just 18 of Texas’ 254 counties are responsible for more suspected home health fraud and abuse than any single state nationwide.
Source: dallasnews.com

Does Obamacare’s Medicaid Expansion Affect You?

Some states, like California and North Dakota, have chosen to take the expanded funding under Obamacare and expand Medicaid coverage to 133 percent of the federal poverty level (up to $32,500 for a family of four). Other states, like Texas and Pennsylvania, will still offer Medicaid coverage based on the state’s own rules for eligibility, but will not be taking federal funding to increase coverage.
Source: findlaw.com

Texas SMP Medicare Scam Workshop

Crockett Resource Center for Independent Living (CRCIL) will be hosting a workshop about the Senior Medical Patrol Project (SMP) on Thursday, August 29th, 2013 at 10:00 a.m.  Presenter, Rick Rameriz, Texas SMP Project Coordinator, reports that there are many different ways Medicare is defrauded and each year, billions of dollars are stolen by scam artists and crooks.  The SMP presentation will educate seniors on how to protect, detect, and report fraud, waste, and abuse of the Medicare system.
Source: countylifeonline.com

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September 30, 2013

How and when to sign up for Medicare

Posted by:  :  Category: Medicare

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If you are eligible, you have the choice of accepting or rejecting Part B coverage. If you want Medicare Part A and Medicare Part B, then you should sign your Medicare card and keep it in your wallet. If you don’t want Part B, you put an “X” in the refusal box on the back of the Medicare card form, and send the form to the address shown right below where your signature goes. About four weeks later, you will get a new Medicare card indicating that you only have Part A coverage.3
Source: stillwatergazette.com

Video: Apply for Medicare | Medicare Sign Up

Daily Kos: Arkansas gets Medicaid expansion waiver

• Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form. • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time. • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery. Much more available from the Google.  Above is NJ.
Source: dailykos.com

How Can I Qualify for Medicare Before I’m 65?

Those younger than 65. Unfortunately, there are limited ways to get Medicare if you’re under 65. You can qualify for Medicare if you are approved for disability benefits from Social Security or the Railroad Retirement Board. However, there is a 24-month waiting period after you become entitled to disability benefits before you can get Medicare. You can also get Medicare coverage if you have end-state kidney/renal disease (ESRD). (For ESRD, you or your spouse need only be “currently insured” with Social Security. If you or your spouse earned six credits in the three years before turning before turning 65 or dying, you are currently insured.)
Source: nolo.com

Sightings Over Sixty: I Apply for Medicare, Part II

     The other day I received an envelope in the mail from the Social Security Administration. I opened it up. I got my Medicare card!      I feel like I’ve been accepted into an exclusive club. Better than AAA; better than AARP; better than my America the Beautiful senior pass to the National Parks.      Now, if I only knew what Medicare covers. And what other medical coverage I should get.      I went through one round of trying to figure out how Medicare works, apart from Parts A and B, as I recounted in I Apply for Medicare, Part I. I did learn some information; but not enough to make me think I could find an appropriate backup plan.      So I phoned my sister. She’s older than I am and has been on Medicare for a couple of years — and I know she’s used the system, so I thought I could ask her how it works.      “You haven’t gotten any information in the mail?” she said, incredulously. “I think I got several mailings. But to tell you the truth, I wasn’t paying attention.” She knew she was going on her husband’s medical plan to supplement Medicare. It’s a good plan and, as she said, “It’s almost free,” and so she didn’t research other options. Some people are lucky. And she was happy getting whatever she would get.      My ex-wife had mentioned that she’d gone to an insurance agent specializing in Medicare plans. The agent had assessed her situation, come up with several options for her and explained the details of both coverage and cost. I googled Medicare insurance agents in my town. The nearest one is a 40-minute drive. Maybe I’d go see him, I said to myself, but let me try to figure this out on my own. I really didn’t want to have to drive that far, on speculation that the agent would know what he was talking about, and know what would be best for me.      Of course, I’d neglected to ask my ex-wife what plan she’d decided on. So I called her back. She told me she’s using a United Health Care plan she got through AARP. That was the one recommended to her by her agent; and so far it was working just fine.      Meanwhile, I’d received two thick envelopes from my own insurance company. I opened them up; and the contents were both intimidating, and discouraging. Oh man, I really didn’t want to read all that mumbo jumbo!      Nevertheless, I gamely opened up the package and started to read through the material. There were several HMO plans. But I want to reserve the option to go to a doctor outside my network, in case I ever need a certain specialist. So I turned to the PPO plans.      I tried to compare PPO I and PPO II and PPO III and PPO “High Option.” I focused on PPO II and PPO III, figuring I didn’t want either the cheapest or the most expensive plan. But it looked to me, as I inspected the columns of benefits, that PPO III is more expensive but offers fewer benefits. That couldn’t possibly be right. So I threw up my hands and gave up. For the moment, anyway. I knew I’d have to go back to it.      Then I thought, I should contact AARP. If it was good enough for my ex-wife, it would probably be good enough for me,      I went to the AARP website. After searching through the site (the insurance plans are hard to find) I found a reference to several AARP Supplemental plans. And I also found a recommendation for Medicare Advantage plan. What’s the difference between Medicare Supplement, and Medicare Advantage? I didn’t know. I’d also seen reference to Medicare Gap plans. What are they?      I decided to call the 800 number. I then spent about 45 minutes on the phone with a woman who explained all about the AARP Medicare Advantage plan that was available in my area. There are several advantages, she explained. It takes the place of Medicare Part C. It includes the Part D drug plan and some dental insurance and some other ancillary benefits.      Then she finally allowed as how the Medicare Advantage plan is an HMO plan. “Oh,” I said. “That means I have to stay in a network?”      “Yes, that’s right. But we have a lot of doctors in the network.”      “Wait a second,” I said, as it finally dawned on me. “Are all Medicare Advantage plans HMO plans?”      “Yes, that’s right.”      “So how can I tell if my medical group accepts this AARP Medical Advantage plan?”      “Oh, I can look it up for you.”      So she put me on hold for a minute. She came back on the line. It turns out my medical group accepts several other United Health Care options. But not this United Health Care Medical Advantage plan. So unless I changed to another doctor in their network, every time I went to the doctor it would be out of network, costing me a fortune.      Were there any other options available to me? I wondered. What about that AARP Supplemental plan I saw on another page of the website?      “Oh, I don’t handle those plans,” said the woman. “They’re administered through someone else.”      So . . . 45 minutes down the drain. But at least I learned that a Medical Advantage plan is an HMO plan, requiring you to go to doctors in their network.      I was drained. No more research today. I quit . . . knowing no more than I knew before — which is that it is easy to sign up for Medicare, but hard to find out exactly what you’re signing up for. But I will figure it out, for sure, for my third and final installment of how I applied for Medicare, coming up (hopefully) next week.     
Source: blogspot.com

Top 10 Reasons to Sign Up for a Medigap Plan

Medigap plans use underwriting. These seems like it would not be a reason to sign up for a Medigap plan. But on the contrary, this is a crucial reason for signing up for a plan when you are eligible. Eligibility is granted by turning 65, losing employer coverage, losing Advantage plan coverage, signing up for Part B for the first time, and several other specific instances. If you do not sign up during one of these periods, you would have to qualify medically for a plan and can be denied coverage or made to pay more (even AFTER 1/1/14 and PPACA).
Source: medicare-supplement.us

Do Mom and Dad Qualify for Medicare Benefits?

Have you considered, discussed, and planned for how your senior’s care will be paid for when he needs extra assistance and care at home? How about if the unthinkable happens and she needs round the clock care in a skilled nursing facility? A recent article by K. Gabriel Heiser, an elder law attorney provides some useful information about Medicaid benefits I would like to share. Please keep in mind that these are guidelines, a starting place and not financial or legal advice. Rather, they give you a starting point to begin the family conversation with your personal legal and financial experts. Medicaid is primarily designed to serve low-income people over the age of 65 but the definition of low income may surprise you. You may also be surprised with how the recent economic challenges have impacted your senior’s retirement security. Some of this information is more or less accurate depending on your individual family and it’s financial situation. I present this discussion because more people are eligible for the Medicaid benefit than believe themselves to be and because I firmly believe families need to explore all their financial options when looking at care options. How we expect to pay for care is as much a part of the family discussion as the type of care that may be needed.
Source: alklifesolutions.com

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September 30, 2013

Medicare Drug Plan Polls Suggest Bright Future for Obamacare

Posted by:  :  Category: Medicare

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Looking back on it, the public’s turnaround from initial rejection to growing support for Part D was understandable. The unfunded $400 billion program that President Bush signed into law in December 2003 was needlessly complex for seniors and unnecessarily expensive for taxpayers. Rather than having the government negotiate prices directly with pharmaceutical firms and add drug coverage into the traditional Medicare program, President Bush and his Republican allies in Congress instead gave recipients subsidies to purchase plans from private insurers. Making matters worse, millions of “dual eligible” already receiving drug coverage from Medicaid had to switch to the new scheme, a process that left millions unable to pay for their prescriptions for weeks in early 2006.
Source: crooksandliars.com

Video: Medicare Part D

How and when to sign up for Medicare

If you are eligible, you have the choice of accepting or rejecting Part B coverage. If you want Medicare Part A and Medicare Part B, then you should sign your Medicare card and keep it in your wallet. If you don’t want Part B, you put an “X” in the refusal box on the back of the Medicare card form, and send the form to the address shown right below where your signature goes. About four weeks later, you will get a new Medicare card indicating that you only have Part A coverage.3
Source: stillwatergazette.com

Employer Action Required! Distribute Medicare Part D Notices by October 15th

Actuarial Value Benefits Benefits Compliance Commercial Insurance Cost-Sharing (Reductions) Employer Mandate Essential Health Benefits Exchanges Exchanges / Marketplaces / Subsidies Grandfathered Plans HCR Overview HCR Timelines Health Care Reform Health Insurance Marketplaces HIPAA HRAs & HSAs Individual Mandate Insurance Market Reforms Large Employers Laws, Regulations & FAQs Marketplaces Medicaid Expansion Medical Loss Ratio & Rebates Minimum Value Newsletters Nondiscrimination Rules Notices & Disclosures (Sample forms) PCORI Fee Penalties Personal Insurance Premium Tax Credit & Advance PTC Press Releases Preventive Services Reporting & Disclosure Reporting Requirements Resources Small Employers State-Specific Information Subsidies Summary of Benefits and Coverage Taxes, Fees & Penalties Timeline Transitional Reinsurance Fee Webinars Wellness Programs
Source: leavitt.com

Healthy Outlook for Medicare Advantage and Part D from CMS in 2014

Last week amid all the ObamaCare drama on the Hill CMS released the 2014 data for Medicare Advantage (MA) and Prescription Drug Plan (PDP) bids. The numbers show a better-than-expected 2013 and a healthy 2014 ahead for Medicare health plans.  The market will see new service areas, lower bids, more zero premium plans, and more mainstreaming of Medicare Advantage as it approaches one-third of the program. CMS noted significant gains on plan quality measures, pointing out that more plans are receiving a rank of four -plus on Star Ratings, the minimum threshold for quality bonuses in 2015 when the quality demonstration expires.  Overall there is clear evidence that CMS quality incentives are working, and that MA will continue its steady ~10% growth in 2014.
Source: gormanhealthgroup.com

Medicare Part D Frequently Asked Questions

Beneficiaries may enroll in a Medicare Part D plan during their Initial Election Period (IEP), which begins three months before they become eligible for Medicare and runs through the three months following their eligibility month. If you miss enrolling during your IEP, you can also join a Part D plan during the Annual Election Period (AEP), which lasts from October 15 to December 7 each year. During their IEP and the AEP, beneficiaries joining a Part D plan for the first time are encouraged to compare all available plans in their area in order to find one that best suits their needs. If you already have a Part D plan, you may use AEP to review its coverage details and determine if your existing plan is still the right plan for you in the coming year. You may want to shop for a new plan if your existing one is going to increase its price or cease coverage of important prescriptions.
Source: planprescriber.com

Medicare Part D Is Working

The American Action Forum released a report Thursday finding the Medicare Part D program has been successful in its first ten years, with significantly lower government expenditures than projected, low beneficiary costs, and high customer satisfaction, according to an AAF release.
Source: freebeacon.com

Medicare Part D: Beneficiary Satisfaction Soars

In a time when government disapproval has grown among the public, Medicare Part D stands as a mark of success for government programs. A national survey released this month by KRC Research of approximately 2,300 seniors (65+), highlights the overwhelming positive response to the program. With almost 10 years since it was first enacted, Medicare Part D appears to one of the most popular government programs in existence.
Source: nhjournal.com

Most Senior Citizens Are Satisfied with Medicare Part D for Prescription Drug Coverage

How well has it worked? A recent survey of retirees concludes that this program has been highly successful. Nine out of 10 people covered by Part D are satisfied with their drug coverage. The program enables seniors to save money and have access to medicine they might otherwise skip. 
Source: peoplespharmacy.com

Medicare Lessons for Senator Cruz

So we went to trainings, gave talks at senior centers, helped people choose plans, and helped resolve problems that prevented some from getting their medications smoothly. Once Part D got started – and it was a rocky start – we even filed lawsuits to make sure that people were actually getting the Part D benefits they were supposed to get, improving the existing program. We did not try to prevent Part D’s implementation, “defund” it, spread falsehoods about it, or try to make it fail.. We tried to make sure people could make the best possible use of Part D, because people needed their medications. We did and still do advocate for changes to Part D (like closing the donut hole, finally being accomplished by Obamacare!). Today there are millions of people who need health insurance and cannot get it. Obamacare will help them get that insurance. (Luckily, there are also people working hard to enroll the uninsured.) This new program may not be perfect, but obstructing its implementation, scaring away people who truly need insurance coverage, placing political gain over the urgent medical needs of real people – those tactics should be out of bounds.
Source: cmahealthpolicy.com

Picking a Medicare D Plan is Nearly Impossible; You Must Do Your Homework

In my job as a general internist in Austell, Georgia, I see many people who have trouble paying for their medicines. In late 2012, an elderly patient came in on the verge of tears. She was unable to pay for her food, mortgage and medicines, so she was going to move in with relatives and let the bank foreclose on her home.  After seeing this, I set up a free nonprofit educational website www.medicaredrugsavings.org. A video on the web site clears up confusing details about Medicare and shows you in a step by step fashion how to find the least expensive plan which covers the medicines which YOU are taking.   The Georgia chapters of the American College of Physicians and the American Academy of Family Physicians (the two main groups for primary care doctors) plan to promote www.medicaredrugsavings.org. The website will be updated to improve the graphics (I found that I’m better at treating diabetes than designing web sites) and provide updated information in the next two weeks.
Source: ajc.com

What is the Difference Between Original Medicare and Medicare Part D?

Another way to get Part D coverage is by enrolling in a Medicare Advantage Prescription Drug (MAPD) plan that combine prescription drug coverage with hospital and medical insurance. However, if a beneficiary chooses to enroll in a Medicare Advantage (MA) plan that does not offer prescription coverage, they may not be able to join a stand-alone Part D plan for medication coverage. The only types of MA only plans that allow a beneficiary to also enroll in a PDP include: Private-Fee-For-Service (PFFS), Medical Savings Account (MSA), or Cost plan. If an MA plan without drug coverage does not allow enrollment in a PDP, beneficiaries should consider looking into switching into an MAPD during the next Medicare Annual Enrollment Period (AEP).
Source: ehealthmedicare.com

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September 30, 2013

Obamacare gets real Oct. 1, and here’s a first look at what it means for all Alabamians

Posted by:  :  Category: Medicare

There is also a chance opponents in Washington will persuade the White House to delay for another year the law’s requirement that every adult who can afford it buy health insurance or pay an annual penalty starting at $95. The White House has already delayed for a year the requirement that businesses with 50 or more employees offer health insurance. This “individual mandate” won’t affect more than about 7.3 million people, some estimates say, because of all of those who are exempt. That group starts with everyone who has health insurance now, including Medicare, Medicaid and veterans’ insurance.
Source: al.com

Video: Alabama Medicare Supplements

Federal government seeks $88 million refund from Alabama Medicaid Agency

2014 election abortion Accountability Act Alabama Accountability Act Alabama Democratic Party Alabama Education Association Alabama Legislature Alabama Medicaid Alabama Republican Party Alabama Senate Arthur Orr Artur Davis bingo Bobby Bright Bob Riley Bradley Byrne Bryan Taylor Campaign 2014 Craig Ford Del Marsh Dick Brewbaker Education Trust Fund Gambling General Fund guns illegal immigration Immigration Jay Love Joe Hubbard Kay Ivey Luther Strange Mark Kennedy Martha Roby Mike Hubbard Quinton Ross Robert Bentley Roger Bedford Ron Sparks Scott Beason Tim James Trip Pittman Troy King Uncategorized VictoryLand Vivian Davis Figures
Source: madvertiserblogs.com

Alabama will try to work a deal on $88 million in Medicaid overpayments it must give back

Williamson said the state has 30 days to respond and needs to work out a deal because that money — the $88 million — has already been absorbed into the Medicaid program. If a settlement can’t be reached, health care to some might be cut or the state would have to find another funding source, he said.
Source: al.com

Left In Alabama:: Poop Happens: New Rules for Alabama Medicaid

African American Political Pundit AmericaBlog An Examination of Free Will Bartcop Blog for Rural America Balloon Juice Blue Gal Booman Tribune Borowitz Report Science Blogs Corrente Crooks and Liars Daily Kos Docudharma Eschaton Firedoglake First Draft FiveThirtyEight Hullabaloo Jack and Jill Juan Cole La Vida Locavore The Left Coaster MyDD My Left Wing NASA Watch Notion’s Capital Oliver Willis Paul Krugman Political Cortex Scoobie Davis Senate Guru Spocko’s Brain Elections@DailyKOS Suburban Guerilla Talk To Action Talking Points Memo The Field Negro The Oil Drum Think Progress US Politics News
Source: leftinalabama.com

Medicare fines Mobile hospitals for excessively readmitting patients

MOBILE, Alabama – Armed with bigger fines and federal muscle, Medicare will punish three out of four Mobile County hospitals with thousands of dollars in penalties in an effort to reduce patients readmitted within a one-month period, according to a report by Kaiser Health News (KHN).
Source: al.com

Baptist Medical Center South in Alabama Told to Refund $1.8M to Medicare

The OIG looked at sample inpatient and outpatient claims at Baptist during 2009 and 2010. The agency said the hospital received net overpayments totaling $242,514. After stratifying that sample size, the OIG estimated Baptist overbilled Medicare at least $1.78 million over those two years.
Source: beckershospitalreview.com

MedicareBob’s Blog: Montgomery Alabama Medicare Supplement Quotes:

Robert Bache aka MedicareBob owns and operate Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: blogspot.com

Montgomery Alabama Medicare Supplement Quotes

Robert Bache aka MedicareBob owns and operate Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: srhealthcaredirect.com

Alabama Medicare Advantage 2014

1. If you are new to Medicare or have never been enrolled in a Medicare Advantage Plan before, you may have heard Advantage Plans referred to as Medicare supplements or supplemental coverage. Nothing is further from the truth. A Medicare Advantage plan is not a Medicare supplement (also known as Medigap), it is merely another way to receive your Medicare benefits.
Source: alabamamedicareadvantage.com

Oregon May Provide Model For Restructuring Medicaid In Alabama

Last October, a commission established by Bentley began researching ways to restructure the state’s Medicaid program to make it more efficient. The group concluded that Alabama should follow Oregon’s path. “It will be a heavy, heavy lift,” says state health officer Don Williamson, who headed the group. But he said the overhaul is necessary if the state is ever going to expand Medicaid. Otherwise, he said, “we will find ourselves with a program that simply collapses under the weight of the expansion.”
Source: kaiserhealthnews.org

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September 30, 2013

MedicareBob’s Blog: Lucas County Ohio Medicare Supplement Quotes

Posted by:  :  Category: Medicare

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The three most comprehensive Medicare Supplement Plans are: Medicare Supplement Plan F: Full Coverage Medicare Supplement Plan G: Small Deductible ($147.00) Medicare Supplement N: Small Deductible & Copays (Part B Excess
Source: blogspot.com

Video: RANT!!!!! DEBT problem; Wisconsin & Ohio; Social Security, Medicare and Taxes

Medicare And “Marketplace Plans”

Problem: Medicare Part A is free for most beneficiaries and goes toward hospitalization and limited nursing home care. Since this fulfills the insurance requirements set by law, those on Medicare do not need anything in addition. For some 20-odd years it has been illegal for private insurers to try and sell their plans to individuals known to be Medicare recipients. This is the result of an effort to keep insurers from taking advantage of Medicare recipients.
Source: davidlefton.com

Mutual of Omaha Medicare Supplement Rates Drop

Tagged With: affordable Medicare premiums, affordable Medicare supplement insurance, Medicare Insurance, Medicare Supplement Insurance, Medicare supplement insurance Nebraska, Medicare supplement insurance Ohio, MedicareBob, Mutual of Omaha, Robert Bache, Senior Healthcare Direct, supplement premiums
Source: srhealthcaredirect.com

Ohio Elder Law and Estate Planning: Guard Your Card To Stop Medicare Fraud

News and Discussion on Ohio Elder Law and Estate Planning, including Medicaid and VA Aid and Attendance, Wills, Living Trusts, Guardianship, Healthcare Powers of Attorney, Living Wills, HIPAA, Probate, and more by Columbus, Ohio Estate Planning Lawyer Russell C. Golowin. For more, visit OhioSeniorLaw.com
Source: blogspot.com

Ohio’s Public Employee Union (OPERS) Loses Spouse Coverage under Obamacare

Conservative Daily News allows a great deal of latitude in the topics contributors choose and their approaches to the content. This is due to our approach that citizens have a voice, not only the mass media. Readers will likely not agree with every contributor or every post, but find reasons to think about the topic and respond with comments. We value differing opinions as well as those that agree. Opinions of contributors are their own and do not necessarily reflect those of CDN, Anomalous Media or staff. Click here if you’d like to write for CDN.
Source: conservativedailynews.com

Ohio Health Policy Review: Medicare mulling star rating system for hospitals

The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes. In a statement, Medicaid officials said that, "Visual cues can be an important way to help patients understand how their hospital measures up to others," adding that the government is interested in hearing from people about "user-friendly, creative designs for a rating system to help patients get information so they can take an active role in their care."
Source: healthpolicyreview.org

Daily Kos: Hey, Ohio! You can sign up for Obamacare, too

I learned a few things: –The exchange policies are also available through an insurance agent at no additional cost to the individual.  The company pays the agent. –Nothing in the exchanges for anyone who is Medicare-eligible.  There are a very few over-65 people who are not eligible for Medicare, and they can buy on the exchange. –The cut-off in my state for Jan 1 coverage is December 23.  It might be different in your state.  If one signs up between Dec 24 and some date in January, coverage begins on Feb 1.  If that date is missed…well, you get the idea. –Medicaid coverage will not have this “processing” period, I’ll call it. –There are many other policies available that are not on the exchange and do not meet all the requirements for the subsidy.  If you won’t get the subsidy, do consult with an agent about other available policies.  In my county there are only two companies with policies on the exchange (actually non-profit Blue Cross and their for-profit subsidiary), but there are six or eight other companies that offer policies not on the exchange. –The list of procedures that require prior authorization has grown.  Check them out. –Something about registering the name of your primary care provider (MD, nurse practitioner, etc.) with the insurance company to get the lowest cost. –Adjusted Gross Income, Form 1040 Line 37, is the income figure they’ll use. –In 2015 they’ll check your 2014 income and do a recalculation of the subsidy you actually should have gotten in 2014.  You may get a bill.  I don’t know if you’d get a check if you came in under the income estimate.
Source: dailykos.com

Planning Of Benefits Have Got Have Medicare

Unblocked enrollment is the exact time when Las vegas seniors should examine their Ohio Medicare plans, consider those health status and the various styles available to them, and find that can one is best suited to their wants and needs. The most important way to make the right option during Medicare start enrollment is on to get professional info from an unbiased health insurance company in Ohio. With vast know how and knowledge the field, a trustworthy reliable agent possibly can help you determine your Ohio Medicare health insurance coverage and cause the changes necessary to improve your health insurance additionally drug coverage.
Source: jeunes-royalistes.org

AAA7 Encourages Medicare Beneficiaries in Gallia County to Attend Medicare Presentation in Gallipolis

Your local Area Agency on Aging District 7, Inc. provides services on a non-discriminatory basis. These services are available to help older adults and those with disabilities live safely and independently in their own homes through services paid for by Medicare, Medicaid, other federal and state resources, as well as private pay. The AAA7’s Resource Center is also available to anyone in the community looking for information or assistance with long-term care options. Available Monday through Friday from 8:00 am until 4:30 pm, the Resource Center is a valuable contact for learning more about options and what programs and services are available for assistance.
Source: galliaherald.com

Managed Care Coming for Beneficiaries covered by both Medicare and Medicaid

Under managed care, enrollees will be limited to the providers who are part of their network. As a result, some people may eventually have to change care providers. But McCarthy said they are “guaranteed continuity of care for one year.” Residents of assisted living facilities and nursing homes would be able to remain in their current facility at least three years.
Source: aarp.org

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September 30, 2013

History of Medicare Insolvency Predictions Since 1970

Posted by:  :  Category: Medicare

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Only the Hospital Insurance (HI or Part A) has the potential of becoming insolvent. Medicare Part A is only considered “insolvent” when revenues and trust funds cannot cover 100% of the costs. Currently trustees predict that revenues and trust funds will only be able to cover 87% of Part A costs in 2026. It should be noted that trustees have consistently predicted such shortfalls since the program began. However, historically presidents and congresses have acted to adjust costs and revenues to keep the program at 100%.
Source: ramirezgroup.com

Video: A Short History on Medicare

History of medicare in Canada

By the time this shift in thinking occurred, decisions had been made about funding healthcare that set the pattern for the future. In terms of financing, many early reports assumed that some of the costs of medicare would be paid directly by patients or taxpayers. The 1939 Rowell-Sirois Report, which dealt with federal-provincial fiscal relations, assumed that contributions from employers and employees would raise most of the money. One of the intellectual architects of Canada’s social programs, Leonard Marsh, wrote in his 1943 report that there were “psychological” as well as financial benefits to having taxpayers pay a part of their healthcare costs. He linked the amount of coverage to the size of contribution made directly by individuals – that is, if more services were to be covered, then individuals would have to pay more directly from their pockets. Tom Kent, Prime Minister Lester B. Pearson’s key policy adviser when medicare was created in the 1960s, recommended that up to 25 per cent of healthcare costs should come from making healthcare a taxable benefit. Kent believed that there was a problem with healthcare being a “free good”. If even a small part of what patients and taxpayers paid for healthcare was related to their use of the system, there would be some restraint on the demand for services. Kent also knew that if medicare were to be funded solely from the general pool of taxes, governments would only be able to cover a narrow range of services.
Source: troymedia.com

The History of Medicare in Seven Minute Video

The arrival of my 50th birthday is prompting me to post this zippy video about  Medicare. It  is written and produced by the Kaiser Family Foundation staff and serves as a visual timeline of Medicare’s history. It cleverly presents the debate that led to Medicare’s creation in 1965 and subsequent changes, such as the passage and repeal of the Medicare Catastrophic Coverage Act in the 1980s, the Medicare Modernization Act in 2003, and the Affordable Care Act in 2012.
Source: chicagonow.com

What You Need to Know about Medicare and the Affordable Care Act

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand. Google+
Source: ehealthmedicare.com

Ryan Revises History on Medicare Reform

The commission was created by Congress as part of the Balanced Budget Act of 1997. The New York Times reported that Clinton appointed just four of the 17 commission members, and all four of them voted against the report. Clinton himself opposed the final draft report. He issued a statement on the day of the vote that criticized the plan for, among other things, potentially increasing premiums for seniors who remain in the traditional government-run Medicare plan. Why? Clinton and other Democrats feared the subsidies would not keep pace with inflation. 
Source: factcheck.org

The history of Medicare and its influence on American health care

Several months ago, it appeared that Congress would tackle the issue of correcting the formula in its healthcare reform legislation, but then senators announced they were going to bring up a standalone bill that would overhaul the formula, replace it with a new one, and erase the accumulated cuts in pay. But that bill failed a procedural vote in the Senate, indicating that an SGR bill that offers no way to pay for itself would not be able to earn support from senators who were on the verge of passing trillion-dollar healthcare legislation in the midst of an economic recession.
Source: kevinmd.com

Medicare comes to Kaiser Permanente

Please do not include any medical, personal or confidential information in your comment. Conversation is strongly encouraged; however, Kaiser Permanente reserves the right to moderate comments on this blog as necessary to prevent medical, personal and confidential information from being posted on this site. In addition, Kaiser Permanente will remove all spam, personal attacks, profanity, and off topic commentary. Finally, we reserve the right to change the posting guidelines at any time, at our sole discretion.
Source: kaiserpermanentehistory.org

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September 30, 2013

Original Medicare vs. Medicare Advantage: Deciding Between the Two

Posted by:  :  Category: Medicare

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There are two main ways for seniors and eligible disabled individuals to get Medicare coverage. When beneficiaries first enroll in the Medicare program, they receive Original Medicare hospital and medical benefits. However, they also have the option to get their coverage through a Medicare Advantage plan, which may include additional benefits like Part D prescription drug coverage. Understanding the difference between Original Medicare and Medicare Advantage will help you decide how you want to receive your Medicare coverage and what costs and benefits to expect.
Source: ehealthmedicare.com

Video: Medicare Part C Overview

Medicare Parts A, B, C, D

-Medicare Part B covers Medically Necessary Services used to treat or diagnosis an illness (Includes things such as Clinical Research, Ambulance Services, DME (Durable Medical Equipment), Mental Health, Second Opinions before Surgery, and Outpatient Drugs) or to prevent an illness.
Source: stratasan.com

Present Tense Magazine.org

Different Medicare plans exist based on different functions of the health care system. People who have the best Medicare Advantage plans have their health coverage paid for by the federal government. The rest of Medicare beneficiaries enroll in what is known as a single-payer health care system. As you consider the choice between different plans, especially any Medicare Part B supplemental plans, here are five facts to keep in mind,
Source: presenttensemagazine.org

Health Subcommittee Examines Proposals for Reform and Improvement of the Medicare Part B Drug Program

Reimbursement rates under Medicare Part B have caused the shift of some patient populations, including those with cancer and other rare diseases, from physician offices to hospital outpatient centers. The reimbursement shift, as coupled with community cancer centers closing, has caused an increased cost to the Medicare system and patients. As Brooks added, “Medicare payments for chemotherapy administration services in hospital outpatient settings have more than tripled since 2005, while payments to community cancer clinics have actually decreased by 14.5 percent.”
Source: house.gov

What is the difference between Medicaid and Medicare?

Comparing Medicaid vs Medicare is extremely important to understanding the health care insurance you may qualify to receive. Some individuals with a extremely low household income may qualify for Medicaid and Medicare. In that case, most medical and prescription drug needs are covered without having to purchase additional health insurance coverage.
Source: qooqe.com

Comparing Part C Medicare Advantage to Original Democratic

The most important reason in my opinion for choosing A/B/C over Original Democratic-Party Medicare is that public Part C Medicare health plans must by law (or long-established CMS regulation) protect seniors against financial catastrophe. Original Democratic-Party Medicare has multiple types of lifetime limits (one for hospitals, another for skilled nursing facilities, another for durable medical equipment, etc.). This huge limitation of Original Democratic-Party Medicare is not changed by Obamacare Adding a private Medigap plan effectively provides such protection but does not guarantee it. In some states, private Medigap plans are available with catastrophic coverage.
Source: typepad.com

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September 30, 2013

How and when to sign up for Medicare

Posted by:  :  Category: Medicare

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If you are eligible, you have the choice of accepting or rejecting Part B coverage. If you want Medicare Part A and Medicare Part B, then you should sign your Medicare card and keep it in your wallet. If you don’t want Part B, you put an “X” in the refusal box on the back of the Medicare card form, and send the form to the address shown right below where your signature goes. About four weeks later, you will get a new Medicare card indicating that you only have Part A coverage.3
Source: stillwatergazette.com

Video: Guide to Medicare Part A and Part B

Medicare RACs Nab $2.2B in Overpayments in Past 9 Months

In the third quarter alone, Medicare RACs recovered $855.3 million, while returning only $36.3 million in underpayments. This means for every dollar a Medicare RAC returned to a provider for an underpayment, it collected $23.56 in overpayments. HealthData Insights and Connolly continue to be the most active RACs, as they each collected roughly $289 million in overpayments in the third quarter. HDI and Connolly audit hospitals in 32 states across the West and South, including Florida, Texas and California.
Source: beckershospitalreview.com

Washington State Insurance Update: “I’m on Medicare Part A and B. I want to drop Part B and buy a health plan through the Exchange so that I can get a subsidy”

Don’t do it. That’s worth saying again: Do Not Do This. Here’s why: Most health insurance plans have language in their policies that lets them drop anyone who is eligible for Medicare. As a result, even if you manage to sign up for the plan, the company will likely eventually figure out that you’re eligible for Medicare and will drop you. Then, if you go back onto Medicare Part B, you’ll have to pay a penalty for as long as you continue to have Medicare. The penalty is 10 percent for each full 12-month period that you could have had Part B. And that’s not all. If you are Medicare-eligible and you purchase a plan offered on the Exchange, you are not eligible for an Exchange plan subsidy. (If you are on Medicare, you are already getting a subsidy, because the federal government pays far more in Medicare costs that current Medicare recipients paid into the program.)
Source: blogspot.com

Ask The Experts: Retirement

Q. I will be retiring from federal service Jan. 31, 2014. I am covered by FERS. I am 65 now and will be 66 when I retire. I enrolled in Medicare Part A during the time frame I was supposed to enroll (when I turned 65) and when I enrolled in Medicare part A, I declined Part B because I have health coverage (Blue Cross/Blue Shield) under the government program for such.
Source: federaltimes.com

FierceHealthcare: Medicare RACs recoup $2.4B in overpayments in nine months

During the third quarter, which ended June 30, RACs recovered $855.3 million in overpayments and gave back $36.3 million in underpayments. The most activity centered on Region D: HealthData Insights, where RAC auditors discovered $289 million in overpayments, primarily due to disputes over medical necessity of minor surgery and other treatment billed as inpatient.
Source: properpayments.org

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Source: federaldaily.com

Ambulatory Surgery Centers Projected to Save Medicare $57.6B Over Next 10 Years

 “With policymakers looking for ways to shore up Medicare’s finances and reduce healthcare spending nationwide, our analysis suggests ASCs offer a win-win for policymakers and patients,” said Adjunct Professor Brent Fulton of the University of California at Berkeley. “Encouraging patients to seek the care they need in ASCs throughout the Medicare system should be an easy decision. Indeed, depending on the future policy environment, the savings generated by ASCs could exceed our $57.6 billion estimate [over the next decade].”
Source: beckersasc.com

Original Medicare vs. Medicare Advantage: Deciding Between the Two

There are two main ways for seniors and eligible disabled individuals to get Medicare coverage. When beneficiaries first enroll in the Medicare program, they receive Original Medicare hospital and medical benefits. However, they also have the option to get their coverage through a Medicare Advantage plan, which may include additional benefits like Part D prescription drug coverage. Understanding the difference between Original Medicare and Medicare Advantage will help you decide how you want to receive your Medicare coverage and what costs and benefits to expect.
Source: ehealthmedicare.com

Income Thresholds For Medicare Part B And Part D Premiums

While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B

RESULTS:   The number of Medicare beneficiaries who used chiropractic spinal manipulation grew 13% from 2002 to 2004, remained flat through 2007, and then declined 5% through 2008. An estimated 1.7 million beneficiaries (6.9%) used 18.6 million allowed chiropractic services in 2008. In inflation-adjusted dollars, allowed charges per user increased 4% through 2005 and then declined by 17% through 2008; payments per user increased by 5% from 2002 to 2005 and then declined by 18% through 2008. Expenditures for chiropractic in 2008 totaled an estimated $420 million. Longitudinal trends in allowed claims for spinal manipulation varied by procedure: the relative frequency of treatment of one to two spinal regions declined from 43% to 29% of services, treatment of three to four regions increased from 48% to 62% of services, and treatment of five regions remained flat at 9% of services.
Source: chiro.org

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Source: federaldaily.com

Railroad Medicare is Part B Medicare for retirees

If a provider or supplier you want to work with participates in Medicare, but states “not Railroad Medicare,” Palmetto GBA recommends that they call Palmetto’s Provider Contact Center at (888) 355-9165. Palmetto’s staff is trained to discuss these matters with all Part B providers and suppliers. They also recommend providers or suppliers visit Palmetto’s website at www.PalmettoGBA.com/RR.
Source: utu.org

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